Archives for June 2012

Lower photo: Sonia didn't like the black lines around her old bridge and crowns. She also wanted straight, white teeth that would give her a beautiful smile. Upper photo: Dr. Huefner replaced her crowns and bridge with all-ceramic non-metal crowns and bridge. He also placed several porcelain veneers. The end result was a beautiful smile, something she had wanted for years!

Sonia from Mission Viejo had always tried to take good care of her teeth. As a youngster she didn’t have much professional dental care. So as a young adult she had much catching up to do. She lost one front tooth and over the years had to have a porcelain-fused-to-metal bridge and many porcelain-fused-to-metal crowns. Her smile finally got to the point where it looked pretty good. But over the years she started slacking off with her dental hygiene and visits to her dentist. By the time she was fifty her gums had receded, and there was a visible black lines around most of her crowns. She started noticing that her crowns were quite yellow compared to her friends’ teeth and Sonia became increasingly self conscious about the appearance of her teeth. It was time for Sonia to see a cosmetic dentist about replacing much of her old, unesthetic dentistry and getting a beautiful smile.

In addition to hating the black lines around her bridge and crowns, Sonia didn't like the space between her front teeth.

She came to our cosmetic dental practice in Laguna Niguel to get Dr. Huefner’s opinion as to what was needed for him to make her beautiful looking teeth. Dr. Huefner’s dental assistant Kathy took digital photographs of Sonia’s teeth and smile, and then together Sonia and Dr. Huefner looked at the photos on the computer monitor screen. “Tell me Sonia, when you look at your teeth what is it that you don’t like and want changed?” Dr. Huefner asked Sonia.

Sonia had been closely looking at all her teeth for months and was able to quickly list several things:

“I especially don’t like the black lines around my old crowns”

“My teeth are yellow, I want my teeth to be much whiter”

“My teeth are crooked”

“I hate the space between my two front teeth, it looks dark”

“My back-side teeth lean in and look darker than my front teeth”

Sonia's new cosmetic dentistry gave her a gorgeous smile. Her teeth were white, straight and very evenly proportioned. The porcelain veneers on her side teeth didn't lean in like or natural teeth did and gave her a much more attractive and full smile.

After carefully listening to Sonia it became apparent that she didn’t want to just correct her bridge and a few old crowns, she wanted a “smile makeover”. Dr. Huefner recommended replacing her porcelain-fused-to-metal bridge with an all-ceramic bridge. He also recommended replacing her porcelain-fused-to-metal crowns with all ceramic crowns. On her back and side teeth he recommended placing porcelain veneers. Thus, when she smiled she would have white, straight teeth, all uniform in color and proportion. It was very clear to Sonia that Dr. Huefner’s recommendations were well founded in order to get the results that she asked for, especially eliminating the black lines around her bridge and crowns.

But Sonia had one more very important question that needed answering. “Dr. Huefner, as I get older if my gums recede, will there be black lines showing again that I will have to contend with?” she asked. Dr. Huefner answered with a resolute “No”, that he would be using all-porcelain restorations without any metal whatsoever underneath the porcelain. The metal underneath the porcelain crowns were the black lines that she was currently seeing in her own mouth. She would never see black lines like she has now around any of her new dentistry that Dr. Huefner would be placing for her.

Sonia preceded with the cosmetic dental treatment that Dr. Huefner recommended, and got a terrific result. A beautiful smile, straight white teeth, no space between her front two teeth, no side-back teeth leaning in, and most importantly, no black lines around any of her crowns.

Vicki Gunvalson and Brooks Ayers of The Real Housewives of Orange County after Brooks' smile makeover with porcelain veneers by Dr. Huefner

In early November The Real Housewives of Orange County star, Vicki Gunvalson, called me on the telephone regarding her boyfriend, Brooks Ayers. If you follow the reality show, you know that Vicki is going through divorce and that Brooks is the new man in her life. Brooks, who is sharing his time between Mississippi and Orange County, didn’t, in his own opinion have a great smile. As a matter of fact, in Vicki’s words, “Brooks’ smile definitely needed some HELP”! Vicki went on to say, “Brooks is a great man. He’s smart, hard working, successful, handsome, and a lot of fun to be with. His teeth and smile just didn’t fit with the Orange County image. Brooks and I think that he really needs an Orange County smile!” Vicki informed me that she chose me to do a smile makeover for Brooks in order to transform his teeth into the great looking, straight, white, “Orange County” teeth. Vicki also told me that she would like to have a film crew in our dental office during parts of Brooks’ smile makeover to document the procedure which would air on TheReal Housewives of Orange County show in the early summer. “Could you do that?” she asked me. My answer was, “Yes… absolutely!” I knew we would have to work fast because his cosmetic dental treatment would have to be completed within a month in order to be filmed for Season 7 of The Real Orange County Housewives which was to begin airing February 7th, 2012.

Brooks had very crooked teeth and his upper right lateral incisor was in cross bite. His teeth were worn short and his upper lip was slightly longer than normal, masking much of his teeth when he smiled. Vicki wanted Brooks to have an "Orange County Smile", with straight, white, perfectly aligned teeth. We had less than a month to accomplish this, as we had to complete his new smile before the last week's filming of "Real Housewives of Orange County."

Vicki brought in Brooks for his first appointment with us, accompanied by TheReal Housewives of Orange County film crew. We interviewed Brooks to find out what he didn’t like about his smile and what he wanted to accomplish. He was quick to point out that he was embarrassed about his smile, that his teeth were extremely crooked and that he was not able to get braces as a child like his children have been fortunate to receive. Vicki contributed to the conversation by explaining that since Brooks is now living in Orange County and that they are a couple portrayed on a reality show, it is important that he look “the Orange County” part. That is when the fun began. Seeing the drama of Brooks and Vicki banter back and forth about his teeth, his lips, his jaws and all his little “flaws” that I needed to correct, I realized our biggest challenges were neither Vicki nor Brooks, but the short time span we had to complete Brooks’ treatment and the correction of the cross bite he had on his upper right, lateral incisor. I explained to them both that ideally he should have braces to move the tooth in cross bite into a normal position, but that would take several months to accomplish. The other alternative would be to remove the tooth in cross bite and make a bridge. Although we prefer not to remove a healthy tooth, doing that would allow me to have the best control over giving him the “Orange County smile” that he wanted as well as staying within his time restraints. They both agreed that if removing one tooth would enable me to create beautiful, straight, white teeth for him within a month’s time that they would do that. So off Brooks went to the oral surgeon and the tooth was removed.

At the "trial smile" (temporary veneer phase), Brooks and Vicki got to preview the smile design Dr. Huefner created for him. Specifically, the "trial smile" is used to determine if the patient likes the length, shape, contour and color of the "new teeth." If he (or Vicki?) didn't approve, then Dr. Huefner would change the design until it met their approval. From the "trial smile" design, Dr. Huefner's ceramist, Dave Stohlman from LK Dental Studio, would make Brooks' final porcelain veneers and porcelain bridges.

A couple days after Brooks had the tooth extracted he returned to our office without Vicki. We prepared his teeth for four porcelain veneers and two porcelain bridges. Then we created Brooks’ “trial smile” which are temporary veneers and bridges that we used as our template for his final porcelain veneers and bridges. This was a very important step, as the “trial smile” is used to verify that we are designing his new teeth to his liking in regards to the size, shape, length, color and alignment of his new teeth. It’s kind of like a “test drive” of the new smile. If you didn’t like the “test drive” on a car, of course you wouldn’t buy it! Good cosmetic dentists use the “trial smile” as a “test drive” of sorts, making sure that the cosmetic dentist and patient are all on the same page before the final cosmetic dentistry is made duplicating the basic design of the “approved” trial smile.

After wearing the “trial smile” for a few days, Brooks was asked to return with Vicki to give his approval. Of course, in this situation, I needed to get approval from both of them. I gathered that Vicki would want to be on board with the design, too. Without Vicki’s approval, I am very sure that both Brooks and I would get our own “reality check” from her. If there was something Brooks and/or Vicki wanted to change, I would make (or note) those changes and finalize the design before sending it to our ceramist, Dave Stohlman, at L.K. Dental lab to adjust.

Two days later, we saw Brooks, Vicki, and TheReal Housewives of Orange County camera crew again in our office to film for the show. We proceeded to take photos of Brooks’ “trial smile.” After which, the three of us looked at the photos and discussed our goals. Were the teeth long enough? Straight enough? Was the shape a masculine smile design that worked well with his lips and face? Did the edges of his teeth nicely follow the contour of his lower lip when he smiled? Once we were in agreement regarding Brooks’ smile design, the actual color needed to be selected. They definitely wanted his “new teeth” to be whiter than the BL4 tooth color of the “trial smile.” I pointed out that since Brooks has a longer upper lip that naturally shadows his teeth, we should over compensate by making his teeth at least one or two shades lighter than they originally requested. Using a custom shade guide by LK Dental Studio made of actual EMax porcelain, Vicki and Brooks chose the whitest natural looking tooth color, BL1.

In choosing the color for Brook's "new teeth," we utilized a custom shade guide of EMax porcelain made by our ceramist, Dave Stohlman at LK Dental Studio. Right, top to bottom: A1,B1. Left, top to bottom: BL4, BL3, BL2 and BL1. Brooks and Vicki chose BL1 for his new porcelain veneers and porcelain bridges.

Now that the details of the smile design were agreed upon, there wasn’t any guesswork for our ceramist, Dave Stohlman, at LK Dental Studio to follow. Once I gave Dave the specific details that Vicki, Brooks and I required, he added in the artistic details – that master ceramists like him do – to make the cosmetic dentistry look exceptionally beautiful and extremely lifelike. Brooks was instructed to wear his “trial smile” (temporary veneers and bridges) for another week while Dave was completing his porcelain veneers and porcelain bridges.

Brooks had an amazing transformation with his smile makeover with porcelain veneers and porcelain bridges. We not only made his new teeth considerably whiter and slightly longer, but they were now straight, without any cross bite. The shape of the teeth created a very masculine smile and improved his self confidence.

The following week, Brooks returned without Vicki. We gently removed his temporary veneers and tried on his porcelain veneers and porcelain bridges for his approval. He loved the BL1 tooth shade and the masterfully created porcelain veneers and porcelain bridges that Dave made for him. We then bonded Brooks’ cosmetic dentistry into place with a porcelain bonding laser and he left very happy with his new smile. The real test would be the following day….”the reveal”…..when Vicki would see Brooks for the first time with his “Orange County Smile.”

The before and after photos of Brooks' teeth show an amazing transformation. One might think that orthodontic braces would have been the only way that crooked teeth could be made straight. However, it was clear that a patient with as many dental problems as Brooks, that cosmetic dentistry is oftentimes the treatment of choice. Can you see which tooth had been removed and replaced with a porcelain bridge?

The next day Brooks returned for his normally scheduled post-insertion adjustment accompanied by TheReal Housewives of Orange County camera crew. We took our final photos of Brooks’ completed smile makeover while anxiously awaiting Vicki’s arrival. Once Vicki arrived, we brought her back to our studio/consultation room and for the first time she saw Brooks with his new smile. I’m not going to spill the beans about the drama of “the reveal” visit – you’ll just have to tune in and watch Season 7 of TheReal Housewives of Orange County. I will spill the beans about one thing, Brooks and Vickie were both so delighted with the results that they both returned together the following week and we did a “couple’s photo shoot” for them (see photo collage at top of the blog).

Brooks Ayers, Vicki Gunvalson's boyfriend and one of the "stars" on the Real Housewives of Orange County reality show needed an "Orange County Smile." We transformed his "crooked, discolored, Mississippi" smile into a stunning "Orange County Smile." No longer is Brooks self-conscious about his teeth and smile.

This professional quality portrait photo shoot that my assistant, Kathy, and I did for Brooks and Vicki is a gift we actually have been doing for most of our smile makeover patients over the last eight years. These photo portraits serve to celebrate our patients’ “new smiles” and new beginnings that their beautiful teeth and improved appearances have created.

In a cosmetic dental practice like ours, we deal with complex smile makeovers like we did for Brooks all the time. But for us, having a film crew in our office while doing such intense dentistry in an extraordinarily short period of time was a new and challenging experience. As you might imagine, there was definitely some stress involved, but we love taking on new challenges and we certainly enjoyed our experience with TheReal Housewives of Orange County reality show. In the end, Vicki was pleased with the results and we were pleased to have met her high level of expectation. I’m also very sure that if she wasn’t pleased, she certainly would have communicated that with me.

Lower photo: Jim's teeth were so crooked that it was very difficult to brush and floss all the plaque away. Eventually the lower right lateral incisor (the one that is taller than all the other teeth) got severe decay on the front near the gum line. Upper photo: In order to treat the decay and make Jim's tooth in alignement with the other teeth a full porcelain crown was placed. If Jim's teeth weren't so crowded then a porcelain veneer or 3/4 porcelain crown could have been used instead.

I just received an email asking is it better to have a “porcelain veneer or porcelain crown”? This person had consults with three dentists regarding what to do about one specific tooth. Two of the dentists recommended a porcelain crown and one a porcelain veneer. So, what is the difference?

The answer is simple. A porcelain crown covers over the entire tooth and porcelain veneers, porcelain onlays and 3/4 porcelain crowns only cover a portion of the tooth. So the answer might be rephrased to is it better to cover the entire tooth or only a portion of the tooth? In general the least amount of drilling on the tooth the better. The underlying tooth would be stronger and less chance of sensitivity the less the tooth is drilled upon. If a tooth has little decay or filling in it and in good alignment with the rest of the teeth, then it’s pretty straight forward that the best treatment is probably either a porcelain veneer, porcelain onlay or 3/4 porcelain crown. However, if the tooth has a lot of decay, a very large existing filling, multiple cracks in the teeth or considerably out of alignment with the adjacent teeth, then a full porcelain crown that covers the entire tooth is most likely the best way to go.

Years ago I was at a dental seminar and they divided the room in half. Then the instructor showed an example of a tooth with a moderate amount of decay and asked all the dentists to answer a question. Half the dentists were asked “if this were your tooth, what restoration would you want done on it?” The other half were asked “in your practice, what is the most common restoration that you place on a tooth like this?” The great majority of dentists who were asked what restoration they would want done for themselves answered they would want an onlay, which is a restoration that requires only minimal drilling of the tooth. The great majority of dentists who were asked what restoration they generally place in their practice answered a full porcelain crown. Although not a scientific study, this is significant for two reasons. First, it is clear that most dentists realize that the least drilling possible is the best for the health of their tooth. Second, that most dentists place full porcelain crown restorations because they are generally quicker and easier to do than porcelain onlays, porcelain veneers and 3/4 porcelain crowns. That in not in any way is meant to say that full porcelain crowns are bad, just that if given a choice by your dentist to do either a porcelain veneer, porcelain onlay or 3/4 crown instead of a full porcelain crown, then your dentist most likely advising the kind of dentistry he would want done in his own mouth, what he/she thinks would be the best for the health and strength of the tooth and longevity of your new restoration.

So in general you might only want porcelain veneers, porcelain onlays or 3/4 porcelain crowns in your mouth. But, that can’t always be done. An example is Jim’s tooth. His teeth were very crowded and overlapping, so much that it was extremely difficult for Jim to brush and floss correctly to remove all the plaque. Eventually Jim’s tooth got a lot of decay on the front, near the gum line. If the tooth were straight and in alignment with the other teeth a porcelain veneer or 3/4 porcelain crown would have been used. But Jim’s teeth were very crooked and the tooth with the decay was so far out of alignment that a full porcelain crown was necessary to treat it.

Is it better to have a “porcelain veneer or porcelain crown” in your mouth? There is no way I could answer that question for you without examining your particular tooth. However if your dentist recommends a full porcelain crown restoration I encourage you to ask if he/she is able to do a more conservative restoration instead, like a porcelain veneer, porcelain onlay or 3/4 porcelain crown. If so, then ask the dentist to explain the advantages and disadvantages of each. But then do one more thing. Tell the dentist that you want the best treatment for your tooth and look right in his/her eyes and ask “Doctor, if this were your tooth, how would you want it treated?” Most dentists will appreciate a patient who wants the best that they can do and will be willing to do a treatment that takes them a little more time and effort.

Bravo filmed three of Brooks' cosmetic dental appointments for the show. This photo is from the trailer clip that shows Vickie and Brooks in Dr. Huefner's studio at the initial cosmetic dentistry consultation.

Another clip from the trailer when Dr. Huefner discussing the cosmetic dentistry treatment with Vickie and Brooks.

Lower photo: Jodi didn't like the way her teeth leaned in and wanted larger teeth and a bigger smile. Upper photo: Dr. Huefner placed eight ultra thin porcelain veneers for her. He made her new teeth slightly wider and longer and instead of angling in, he made them angle out slightly to give her a bigger smile.

Jodi, a forty year old sales lady from Irvine, didn’t like her teeth. The first thing she said to us was “I want a big smile!” This can mean a lot of different things, so before Dr. Huefner could recommend cosmetic dentistry treatment he needed to find out more. Specifically, what did “big smile” mean to Jodi?

She explained that she felt her teeth were too small and that when she smiled she wanted to “show more teeth.” She wanted teeth that were larger and a little longer. She also told us that she had braces as a child and that before they would start her orthodontics they had to pull several of her teeth. After looking at Jodi’s teeth we could see that the main problem wasn’t that her teeth were small, but the old orthodontic technique that was used to straighten her teeth twenty years ago was extracting teeth, and then using braces to unravel the crooked teeth and then close the remaining spaces. Unfortunately in Jodi’s case this technique constricted her dental arch, making her teeth angle inwards, giving a much smaller display of teeth. This is most likely the main reason she didn’t have a big smile.

When Jodi smiled she felt her teeth were too small. This was partly due to having four teeth extracted and braces which angled her teeth inwards. Today most orthodontists strive to avoid this end result and instead of extracting teeth as much they use an improved technique called "expansion".

Over the past few decades orthodontic techniques have changed drastically, and orthodontists use techniques called “expansion of the dental arch” and teeth are extracted much less often. Unfortunately the “constriction” of Jodi’s dental arch was something we had to deal with now.

After explaining this to Jodi she was a bit frustrated. “But what can you do to give me a big smile now?” Jodi asked.

The answer to solve Jodi’s problem was to place porcelain veneers on eight of Jodi’s upper teeth. That would angle her teeth back out to a normal position. Also this would allow Dr. Huefner to make her teeth a little wider and longer, giving her slightly larger looking teeth.

Jodi was happy that we had a solution to her problem, but that raised another question. “I really don’t want my teeth drilled on,” she stated most emphatically. “Can’t you do Lumineers?” Jodi had seen the ads in magazines many times which said that Lumineers are a type of porcelain veneers that can be used without any drilling on her teeth. She had a good point which is shared by pretty much everybody. After all, who likes having their teeth drilled on! However in Jodi’s case placing Lumineers on her teeth without any tooth preparation whatsoever would result not only in larger teeth, but most likely unacceptable huge looking thick teeth! Dr. Huefner explained that the technique he would use for her was minimal preparation veneers and that he assured her that he would do the least drilling possible and use the thinnest veneers to give her the result she was looking for….ultra thin veneers!

Jodi got the big smile with eight ultra thin porcelain veneers by Dr. Huefner. Her new teeth were slightly longer and wider and angled out slightly, which gave her a much more attractive smile.

After more discussion Jodi started to get excited. Dr. Huefner explained that it only takes a couple weeks to do the whole ultra thin porcelain veneer process. “Can I choose the color?”, she asked. Dr. Huefner explained that he will give his recommendations, but in his practice the patients always make the final choice in the color of the ultra thin porcelain veneers. “How about the length of the teeth, you will make them longer, won’t you?” she said. Dr. Huefner explained that he will make her teeth wider and longer, and that before he bonds her ultra thin veneers onto her teeth she will have the opportunity to see the new veneers on her teeth and she will have to give him her written approval. If she doesn’t approve of the shape, length or color, Dr. Huefner will make appropriate changes before he permanently bonds them into place.

With all of her questions answered, Jodi was ready to begin her ultra thin porcelain veneer treatment to get the big smile she asked for. She chose shade BL2 for the color and Dr. Huefner made her eight ultra thin porcelain veneers in just a couple weeks as he had promised. Jodi got the “bigger teeth” that she had always wanted and is now very happy with her beautiful smile!